Anindita Bose¹*, Manisha Banarjee², Chandan Kumar Shaha³, Shukla Saha⁴, Arifin Nahar⁵, Monisha Barman⁵, Dhananjoy Dey Biplab⁶ and Arup Kumar Biswas⁷

¹Specialist, Neonatology, Square Hospital LTD, Dhaka, Bangladesh
²Professor, Department of Neonatology, Dhaka Medical College Hospital, Dhaka, Bangladesh
³Assistant Professor, Department of Neonatology, Dhaka Medical College Hospital, Dhaka, Bangladesh
⁴Associate Consultant, Department of Paediatric Cardiology, Square Hospital LTD, Dhaka, Bangladesh
⁵Senior Specialist, Department of Neonatology, Evercare Hospital, Dhaka, Bangladesh
⁶Junior Consultant, Surgery, Bakergonj Upazila Health Complex, Bakergonj, Barisal, Bangladesh
⁷Medical Officer, Department of General Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

*Corresponding Author: Anindita Bose, Specialist, Neonatology, Square Hospital LTD, Dhaka, Bangladesh. Email: drbose.dmc@gmail.com.

Received: July 24, 2023; Published: August 01, 2023

Abstract

Background: Disseminated Intravascular Coagulation (DIC) is a common and complex problem from both the clinical and laboratory diagnostic stand-point, with many available laboratory tests being tested and used to be of diagnostic significance. Disseminated intravascular coagulation (DIC) is a life threatening complication of neonatal sepsis. Subclinical DIC may be present in neonatal sepsis. D- dimer is a fibrinogen degradation product, level of which is increased in DIC. So, D- dimer can be used as a diagnostic marker for early detection of in neonatal sepsis.

Objectives: To determine D-dimer as a marker of early detection of DIC in neonatal sepsis in term newborns.

Methods: It was a Descriptive observational study conducted in the Department of Neonatology, Dhaka Medical College Hospital, Dhaka from June, 2018 to November, 2018. Total 50 patients with clinical signs and symptoms of sepsis with positive sepsis screening were enrolled in this study and D- dimer was tested in all of them. Then D-dimer level was compared between culture positive and culture negative sepsis. Also, association between level of D- dimer and platelet count was determined and diagnostic efficacy of D- dimer for early detection of DIC in neonatal sepsis was calculated. AH the enrolled neonates were followed up for next 7 days for subsequent development of clinical DIC. Also the patients with raised level of D- dimer were observed for immediate outcome within 7 days. Data were collected by active participation and interviewing the mother or caregiver. A pre-formed structured questionnaire was used to collect all the necessary data. Data were analyzed in SPSS version 20.0.

Results: Among 17 culture positive patients, 10(58.82%) and 7(41.17%) were from >3 days and <3 day’s age group respectively. Conversely, among 33 culture negative patients 19(57.57%) and 14(42.42%) were from >3 days and <3 day’s age group respectively. Out of 17 patients in culture positive group 11(64.7%) and 6(35.29%) were male and female respectively. Among 17 culture positive patients, 14(82.35%) and 3(17.64%) had D-dimer level >0.5 pig/ml and <0.5 g/ml respectively. On the contrary, among 33 patients in culture negative group, 12(36.36%) and 21(63.63%) proclaimed >0.5 g/ml and <0.5 g/ml D-dimer respectively. The mean D-dimer level in culture positive and negative groups were 1.96(0.1-6.2) and 1.37(0.1-3.2) respectively. Among 17 culture positive cases, 7(41.17%) 5(29.41%) and 4(23.53%) cases had E. coli, Klebsiella and Pseudomonas respectively and whereas only 1(5.89%) case showed Candida. Among 26 patients with raised D-dimer, 17(65.38%) had thrombocytopenia and 9(34.61%) had normal platelet count whereas among 24 patients with normal D-dimer, only 1(4.16%) had thrombocytopenia. For early detection DIC of in neonatal sepsis, sensitivity, specificity, PPV, NPV and diagnostic accuracy of D- dimer were 94.44%, 71.87%, 65.38%, 95.83% and 80% respectively. In culture positive group, 2(11.76%) developed subsequent DIC who had higher D-dimer level. Conversely, none of the culture negative patients developed DIC later irrespective of normal and higher D-dimer level. Out of 14 higher D-dimer patients in culture positive group, 3(21.42%) died and 2(14.28%) experienced persistent organ dysfunction and on the contrary, out of 12 higher D-dimer patients in culture negative group, 1(8.33%) died and experienced persistent organ dysfunction, each.

Conclusion: D-dimer may be used for early detection of DIC without overt clinical features in neonatal sepsis.

 Keywords: Disseminated Intravascular Coagulation (DIC); D- dimer; Neonatal Sepsis; PPV; NPV

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Citation

Citation: Anindita Bose., et al. “D-Dimer as A Marker of Early Detection of DIC in Term Newborns with Neonatal Sepsis”. Acta Scientific Paediatrics 6.8 (2023): 01-11.

Copyright

Copyright: © 2022 Anindita Bose., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.